Eating Disorders

Question 1

ED Organisations

Answer 1

ANZAED & NEDC: Australian & New Zealand Academy for Eating Disorders; National Eating Disorder Collaboration.

Question 2

Prevalence

Answer 2

• 16.3% of people show disordered eating behaviors.
• 6.7% meet criteria for AN/BN/BED in community cases.
• Adolescents: 3% girls, 1% boys

Question 3

Types of Eating Disorders (EDs)

Answer 3

Anorexia Nervosa (AN): Fear of weight gain, food restriction, excessive physical activity.

Bulimia Nervosa (BN): Binge eating followed by compensatory behaviors like purging.

Binge Eating Disorder (BED): Episodes of overeating with loss of control, no purging.

OSFED: Patterns not fitting strict criteria (e.g., atypical AN, orthorexia).

Question 4

Psychiatric Comorbidities

Answer 4

Anxiety disorders (PTSD, OCD).
Mood disorders.
Personality disorders, self-harm, suicidality.
Substance and alcohol abuse.

Question 5

Medical Complications

Answer 5

Cardiovascular: Arrhythmias, low BP, heart failure.

GI System: Vomiting damages esophagus, laxatives harm GI tract.

Endocrine: Malnutrition causes amenorrhea, low testosterone.

Neurological: Severe malnutrition leads to seizures or brain damage.

Bone Health: Decreased density, fractures, osteoporosis.

Question 6

ED Behaviors

Answer 6

Food avoidance, body checking, binge eating, laxative use, over-exercising, purging, and disordered behaviors like diluting drinks or chewing food and spitting it out.

Question 7

Screening Tools

Answer 7

Questions: “Do you have concerns about eating or weight?”

SCOFF Tool: Yes to 2+ suggests further evaluation.

Question 8

Medical Admission Indicators

Answer 8

Weight: BMI <14.
K+: <3 mmol/L.
Temperature: <35°C.
BP: Systolic <80 mmHg.
HR: <40 bpm or significant postural tachycardia.
Other labs: Low Na+, Mg2+, PO4, Albumin; ECG abnormalities.

Question 9

Treatment Aims

Answer 9

Inpatient: Stabilize weight/BMI, stop ED behaviors, initiate multidisciplinary care.

Outpatient: Maintain weight restoration, normalize eating, reduce anxiety with feared foods.

Question 10

Nutrition Guidelines

Answer 10

Energy:
Low risk RFS: Start at 1800 kcal/day; increase to 3000+ for weight gain.
High risk RFS: NG feed at 1400 kcal/day, gradually increase.

Outpatient: Promote variety, include fats, calcium-rich foods, and feared foods.

REAL Food Guide:
Daily: CHO, proteins, calcium, fruits, veg, water.
Include: Nuts, oils, fun foods.

Question 11

Biochemical Markers for EDs

Answer 11

Electrolytes: Na 135-145 mmol/L; K+ 3.5-5.1 mmol/L.
CBC: Hb, WBC, PLT for anemia.
CMP: Monitor liver/kidney function (ALT <45 U/L, AST <35 U/L).
Glucose: FGL 4-6 mmol/L.
Hormones: TSH 0.5-5 mIU/L.
Bone Markers: Albumin 35-50 g/L, Mg 0.7-1.05 mmol/L.
Cortisol: 140-650 nmol/L (morning).